01120090 (2) CUPERTINO
CI out of c DIVIISIiONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10401 N BLANEY AV FOREMOST HEATING 01120090
OWNER'S NAME: APPLICATION SUB DATE
PRASAD J U B V AND SUJATHA LJTN 770 CHESTNUT ST 12/21/2001
• PHONE: SANITARY NO. CONTROL NO.
_ (408) 287-9234
O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
w BLDG ELECTu PLUMB N EC
�>w
u —
FF LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Job Description
Op: Ow
with Section 7000)ofDivision3ofineBuzincssandPmfessionsC«le.and mylicense FURNACE REPLACEMENT 91, 000 BTU.
re ^�x
la full farce and eff t _A(S.,�r
z a LiceIsnse Clys. f e
Date Cenuacor
11 L ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
dca0 Licenud Pmfexsimnal
taca OWNER I ma GUILDER DECLARATION
i '-`'" 1 hereby antic that 1 am eBusin from the Cession is License Law for he,
fallowing rtmaa(Seaton 703L!,Business and Professions Code:Any city or county $1 S O O
E F O which requires n permit re cousm:n,applicant
Improve demolish,or repair any swcmca
3 _priorwint Issuance.also rcgo Bad Neapplicant for socapemfttofilessigned(Chapter 4GpSectio to00)of ON cited
rhe Ce B.,inrs Licensetaw(Chapter9 p Gµw-�lpp _
m that a I,as po damform and the bacon l of rhe Busin ascamp Professions Code) (�'$;)s i y+3.lsb'3 3.V(J L r , .. ,,,- —Valuation
].psi
or thathei7 exempt thercfrorri and the basis for the alleged aun(pdom.Any violation
of not mom than v any dred olj ficrs a permit subjects the applkunt to a civil penalty- prl }���
nr not more than Eve bartered d°Ilmx(ssoo). 301APN tLUUC3H PLUMBIN '-' � Occupancy Type
❑I,as owner of the property,or my employees with wages as their sole compenwtion.
will do the work:and the structure is not intended or offered sale(ger.7046.- Z3 - - - - --
Business abeiProfessions Code The Contractor's a«ase Law does not apply to an 3 04 - ROUGH EAI4fl°P I tMMctionsu
• '
owner of property Who builds or improves Merton,and who does such work himself
or through his awn employees.provided chat such improvements are not intended or 505_- ___FINAL-,ELECTRICAL,,.-
completion,
.ELECTRICAL..._
offered for"sAe.If.bravcver,the bidding —_ _ _ -- __-- _ _----'
comletion,the owner-builder will have burdwof proving
chat he did nes build or 507 - FINAL PLUMBING -
p proving mat he em not guild or
improve forporpase fsula.). 508 — FINAL MECHANICAL "
❑L tr ownerofthe progeny,am exclusively dcontractingProfessi with licensedcontractorsContracts to ,
construct the does not
(See. to
Business and Professions Codc)The Contractor'sLic
and nsewho
Law docs not puc t wrier f property woo) IJ. improve,,tM1to do
-: and ho.contracts fo h p j ns ,oh contractors) licensed pursuant m the ..._ _ .._.-..___..... . ..... . ._/. .. _.-..
antract License Law. ^ ... . .._._-_ ...-_...
❑1 ecrapt and,1 Sec. B&P C for this cameo ��-�� -
Ow - Date -
WORKER'S COMPENSATION DECLARATION
I hereby action undevpenalty of perjury one of the following deelmations:
C 1 have and will maintain a Certificate of Consent to self-insure for Worker's
Compcnsnion, ax provided for by Section You) of the Labor Code, for the
performance of inn work for which cis permit is issued..
❑1 have and will nninmin Wcolocr s Co urs,r ams Insurance,as required by Seedoe
-' 37W of rhe Labor Cade,for the perfortnedce of the work for which this permit is
issued:My Wmker's Cnnpch.smlon Insurance carrierand Policyoumber are:
Gamete . t' '.Poky No.
', RTI ` s i:-• .
IGEFIGATIDNON OF C%EMPI'ION FROM1I WORKERS' _:} 1 .' \t!t
COMPENSATION INSUft0.NCE
(Tb txnn3n need not he completed if the permit is for one hundred dollars , t. - L
(SI W)or lest)
...
erx°'i�:°�5°8181 j
un comm
t(, I n ry to rR ane the work for which th tN,1 i -
Coltion)Lawsy O APPLIrkrs aft smakingthis Cisimot o of Exemption you Should -
Z become uhj to theta Workers C pensast p ons of the Labor mvo you must
Q 0 forthwith r nilly with h p is m thispermit shall be deemed revoked
Z UI _.-. - O .GE _.. .- _-_ ....__-._ -. . ... . ........... .
f" �. � �.` "'CONSTRUCTION LENDING AGENCY '. ,' .. . . - _ _.... -------
UI
t....
�- "'1 hereby affirm that there is a construction lending agency for the performance
t, of he work far which'his perm t is Issued(Sec 3097.Civ C.I
-Lend .N ....._: .. _,. __.. _. . . ..
Z Lend Addrass 1
V'01 Gentry that I have read this application and state that me above information is s
'IT+ cotter"1 agree to comply with all city,and county ordinances and state laws relating
O U to the building .t i t Ihereby oho p e t tads ath':city to ter upon
�,,.rthe cdon,a inentionedD ,,,ty for in,pen p "
F.. C es.1 ag t dem ke p h mics he C ty of Cupcn'- against
Jl liub i e 1 dg r. c .is x h ch may ay a against said
Ciry sequence of th g f per t r
APPLI CANT UNOERST SVU V ILLCOV ITH ALL NON-POINT"
gouece REcu'unons�� Issued by: Date /��Z
gignaue of wpowanUComr�.'—Data Re-roofs .
HAZARDOUS MATERIALS DISCLOSURE
Will'he ppren t 1 i "b dd'mg' - port slam.1 handlehazamous numal .T e of.Roof.
is d road by th C peal M ipal Cod Chapt 9 12,and th H alth and Safety p - -P- "'Y' ' os" •^code,Section Sect o-2553 w1 z - YP 4 x' ._ x'-, I_bet i .
oY -
wll In gilt t r soul - _.All roofs shall be ms,ected nor to an roofin materia 'ng installed.
s n t each i e .wn ch If a roof Is installed without first obtaining an inspectton;'I agree to'remove m
emit n ti it cant ants as Jet n y Ih Bay Area A Q ty Management
...`.
District? _ all new materials for inspection._Applicant understands and will comply with.
°Y all non-point source regulations.
�- I have read the h card m nriala y ucreard ender Ch pt r 695 of the ` '
Cal'fomaHwIth .N,Senionx2 05 -5533 and 25536.1.ondcntand mat
if me MiildingJ snore ndy haves¢ t t a itis my responsibility to notify the
occupant of the rt u which mt be t i prior'n,issuance of a Cenifcae of e
oeenpanry. - Signature of Applicant Date
12-2110
Owner to au oicial cbda, Date All roof coverings to be Class "B" or bettei
.. .. . '.. . ._. : .:. . ._"OFFICE , - . . . .. ... . .. _.-